Ten steps to transform ideas into product innovations: An interdisciplinary collaboration between nursing and engineering.

AIMS: To describe the development process of a device from the conception of the idea to the first contact with the commercial environment, and to demonstrate its practical application through an interdisciplinary collaboration between nursing and engineering for the design of a protective device for peripheral venous catheters. BACKGROUND: Nurses are key agents for identifying unresolved needs or problems related to nursing care. To address these needs, creative ideation processes are often triggered among nurses to seek technological answers to these challenges. RESULTS: The ten steps to develop a device are presented: (1) detecting an unsatisfied clinical need; (2) searching for preexisting marketed products; (3) searching for patents; (4) maintaining confidentiality throughout the process; (5) obtaining institutional support; (6) forming a multidisciplinary team; (7) developing the idea; (8) applying for a patent; (9) building the prototype; (10) marketing the device. This methodology was applied to design a protective device for peripheral venous catheters in hospitalized patients. CONCLUSIONS: Nurses can play a key role in the promotion of healthcare innovation in their field to improve procedures, thanks to their direct contact with patients, and by providing their insight on devices that can enhance patient care. The successful interdisciplinary collaboration between nurses and engineers can provide a response to relevant clinical problems such as the manipulation or removal of peripheral venous catheters. IMPLICATIONS FOR NURSING AND/OR HEALTH POLICY: A hospital policy is required to encourage the participation of nurses in innovative actions. Furthermore, it is important to support nurse leaders who can play a pivotal role in incorporating creativity into work environments and empowering other nurses to innovatively address clinical issues. NO PATIENT OR PUBLIC CONTRIBUTION: This article describes the process for developing a health device.

[Reacciones de las mujeres ante el folleto del Programa de Detección Precoz del Cáncer de Mama.] / Women's reactions upon reading a leaflet on Breast Cancer Screening Program.

OBJECTIVE: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowing how women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was to explore women's reactions regarding BCS leaflet. METHODS: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age in Asturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematic analysis was carried out. RESULTS: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimed at prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalent attitudes towards BCS were detected, related to emotions. CONCLUSIONS: The emotional response after reading the brochure is ambivalent, although most of the women express positive emotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important to understand how certain emotions (especially negative ones) are closely related to the attitude towards BCS.

OBJETIVO: El folleto del Programa de Detección Precoz del Cáncer de Mama (PDPCM) es una importante herramienta de difusión de ese programa. Conocer la percepción de las mujeres sobre ese material informativo es relevante para entender mejor su actitud hacia el PDPCM. El objetivo del estudio fue explorar las reacciones de las mujeres respecto al folleto del PDPCM. METODOS: Se realizó un estudio cualitativo descriptivo en mujeres de entre cuarenta y sesenta años en Asturias (España). Se realizaron veintiséis entrevistas semiestructuradas a mujeres de diferentes perfiles socioeconómicos en 2018. Se realizó un análisis de contenido para identificar inductivamente las categorías emergentes. RESULTADOS: La lectura del folleto despertó emociones positivas como tranquilidad, bienestar o gratitud, pero también miedo o inquietud. Las mujeres expresaron diversas creencias sobre el CM (enfermedad muy prevalente y de elevada supervivencia), sobre el PDPCM (programa dirigido a la prevención y que suponía una actividad normalizada en su entorno) y sobre el relevante papel de los servicios de salud y los medios de comunicación. Se detectaron actitudes ambivalentes hacia el PDPCM y estas actitudes estaban relacionadas con las emociones. CONCLUSIONES: La respuesta emocional al leer el folleto es ambivalente, aunque la mayoría de las mujeres expresan emociones positivas. Las mujeres comparan la información con sus creencias previas, especialmente respecto al CM y al PDPCM. Es importante entender cómo ciertas emociones (especialmente las negativas) están estrechamente relacionadas con la actitud hacia este programa.

Reacciones de las mujeres ante el folleto del Programa de Detección Precoz del Cáncer de Mama / Women’s reactions upon reading a leaflet on Breast Cancer Screening Program

Fundamentos: El folleto delPrograma de Detección Precoz del Cáncer de Mama (PDPCM) es una importante herramienta dedifusión de ese programa. Conocer la percepción de las mujeres sobre ese material informativo es relevante para entender mejor suactitud hacia el PDPCM. El objetivo del estudio fue explorar las reacciones de las mujeres respecto al folleto del PDPCM. Métodos: Se realizó un estudio cualitativo descriptivo en mujeres de entre cuarenta y sesenta años en Asturias (España). Serealizaron veintiséis entrevistas semiestructuradas a mujeres de diferentes perfiles socioeconómicos en 2018. Se realizó un análisisde contenido para identificar inductivamente las categorías emergentes. Resultados: La lectura del folleto despertó emociones positivas como tranquilidad, bienestar o gratitud, pero también miedo oinquietud. Las mujeres expresaron diversas creencias sobre el CM (enfermedad muy prevalente y de elevada supervivencia), sobreel PDPCM (programa dirigido a la prevención y que suponía una actividad normalizada en su entorno) y sobre el relevante papel delos servicios de salud y los medios de comunicación. Se detectaron actitudes ambivalentes hacia el PDPCM y estas actitudes estabanrelacionadas con las emociones. Conclusiones: La respuesta emocional al leer el folleto es ambivalente, aunque la mayoría de las mujeres expresan emocionespositivas. Las mujeres comparan la información con sus creencias previas, especialmente respecto al CM y al PDPCM. Es importanteentender cómo ciertas emociones (especialmente las negativas) están estrechamente relacionadas con la actitud hacia este programa.(AU)

Background: Breast cancer screening (BCS) leaflets are important for outreach and dissemination of BCS programs. Knowinghow women perceive these leaflets is relevant to better understand their attitude towards BCS. The objective of this paper was toexplore women’s reactions regarding BCS leaflet. Methods: A simple descriptive qualitative design was performed involving women aged between forty and sixty years of age inAsturias (Spain). Twenty-six semi-structured interviews were conducted with women of different socioeconomic profiles in 2018. Thematicanalysis was carried out. Results: Reading the leaflet elicited positive emotions such as peace of mind, well-being or gratitude, in addition to fear or anxiety. The women expressed various beliefs about breast cancer (highly prevalent and high survival rates), about BCS (a program aimedat prevention, a normative activity among their peers) and about the relevant role of health services and the media. Ambivalentattitudes towards BCS were detected, related to emotions. Conclusions: The emotional response after reading the brochure is ambivalent, although most of the women express positiveemotions. Women compare the information with previous beliefs, especially regarding breast cancer (BC) and BCS. It is important tounderstand how certain emotions (especially negative ones) are closely related to the attitude towards BCS. KEYWORDS: Early detection of cancer; Leaflet; Breast cancer; Emotions; Qualitative research; Health knowledge, attitudes, practice.(AU)

Patrones de alimentación y crecimiento de los niños prematuros a los 3-4 años de vida / Feeding and growth patterns in preterm children at 3-4 years of age

Objetivo: describir el patrón de alimentación y crecimiento de los niños prematuros en edad preescolar, incluyendo los problemas de alimentación basados en sus conductas y habilidades, la calidad de la dieta y el afrontamiento de sus padres. Métodos: estudio transversal de niños prematuros nacidos en Asturias en 2016 (n = 94). A los 3-4 años se contactó con las familias y se utilizó el cuestionario Behavioral Pediatrics Feeding Assessment Scale para identificar problemas en la alimentación, y el índice KIDMED para resumir la calidad de la dieta. También se recopilaron datos antropométricos autoinformados para evaluar el crecimiento ponderal. Se revisaron las historias clínicas electrónicas para recopilar información gestacional y neonatal. Resultados: el 7,4 % de los niños y el 20,2 % de los padres presentaron problemas relacionados con la alimentación infantil. El 25,5 % tenían un patrón dietético de alta calidad. En los prematuros < 32 semanas se identificaron más conductas alimentarias alteradas, disminuyendo su frecuencia al incrementarse su edad gestacional (p = 0,030). No se observaron diferencias en las conductas de los padres (p = 0,455), ni en la calidad de la dieta según la edad gestacional (p = 0,399), pero sí en el peso, que fue menor en los muy prematuros (p = 0,015). Conclusiones: el patrón de alimentación de los prematuros a los 3-4 años y las estrategias de sus padres fueron adecuados, y la calidad de la dieta moderada. Es importante un adecuado seguimiento de los prematuros con menor edad gestacional, ya que presentaron más dificultades en la alimentación y menor peso.

Aim: to describe the feeding and growth patterns of preterm-born children at preschool age, considering feeding problems based on behaviours and skills, diet quality and parental feeding practices. Methods: a cross-sectional study was performed on preterm children born in Asturias (Spain) in 2016 (n = 94). When preterm-born children reached 3-4 years of age their families were asked to complete the Behavioral Pediatrics Feeding Assessment Scale and a food frequency questionnaire to identify possible feeding problems and assess diet quality (KIDMED index), respectively. Self-reported anthropometric data were also collected to assess weight growth. Electronic health records were reviewed to gather gestational and neonatal clinical data. Results: feeding problems were found in 7.4 % of children and 20.2 % of parents. According to the KIDMED index, 25.5 % of children had a high-quality diet. Feeding problems were higher in children born before 32 weeks of gestation, and decreased in frequency as the gestational age increased (p = 0.030). No differences were found in parental feeding practices (p = 0.455) or diet quality according to gestational age (p = 0.399), but body weight at 3-4 years was lower in preterm-born children (p = 0.015). Conclusions: feeding patterns of preterm-born children were suitable at the age of 3-4 years, but diet quality was moderate to poor in the majority of children. Follow-up of very preterm children beyond 3-4 years of age becomes necessary as they displayed more feeding problems and lower body weight. (AU)

[Feeding and growth patterns in preterm children at 3-4 years of age]. / Patrones de alimentación y crecimiento de los niños prematuros a los 3-4 años de vida.

Introduction: Aim: to describe the feeding and growth patterns of preterm-born children at preschool age, considering feeding problems based on behaviours and skills, diet quality and parental feeding practices. Methods: a cross-sectional study was performed on preterm children born in Asturias (Spain) in 2016 (n = 94). When preterm-born children reached 3-4 years of age their families were asked to complete the Behavioral Pediatrics Feeding Assessment Scale and a food frequency questionnaire to identify possible feeding problems and assess diet quality (KIDMED index), respectively. Self-reported anthropometric data were also collected to assess weight growth. Electronic health records were reviewed to gather gestational and neonatal clinical data. Results: feeding problems were found in 7.4 % of children and 20.2 % of parents. According to the KIDMED index, 25.5 % of children had a high-quality diet. Feeding problems were higher in children born before 32 weeks of gestation, and decreased in frequency as the gestational age increased (p = 0.030). No differences were found in parental feeding practices (p = 0.455) or diet quality according to gestational age (p = 0.399), but body weight at 3-4 years was lower in preterm-born children (p = 0.015). Conclusions: feeding patterns of preterm-born children were suitable at the age of 3-4 years, but diet quality was moderate to poor in the majority of children. Follow-up of very preterm children beyond 3-4 years of age becomes necessary as they displayed more feeding problems and lower body weight.

Introducción: Objetivo: describir el patrón de alimentación y crecimiento de los niños prematuros en edad preescolar, incluyendo los problemas de alimentación basados en sus conductas y habilidades, la calidad de la dieta y el afrontamiento de sus padres. Métodos: estudio transversal de niños prematuros nacidos en Asturias en 2016 (n = 94). A los 3-4 años se contactó con las familias y se utilizó el cuestionario Behavioral Pediatrics Feeding Assessment Scale para identificar problemas en la alimentación, y el índice KIDMED para resumir la calidad de la dieta. También se recopilaron datos antropométricos autoinformados para evaluar el crecimiento ponderal. Se revisaron las historias clínicas electrónicas para recopilar información gestacional y neonatal. Resultados: el 7,4 % de los niños y el 20,2 % de los padres presentaron problemas relacionados con la alimentación infantil. El 25,5 % tenían un patrón dietético de alta calidad. En los prematuros < 32 semanas se identificaron más conductas alimentarias alteradas, disminuyendo su frecuencia al incrementarse su edad gestacional (p = 0,030). No se observaron diferencias en las conductas de los padres (p = 0,455), ni en la calidad de la dieta según la edad gestacional (p = 0,399), pero sí en el peso, que fue menor en los muy prematuros (p = 0,015). Conclusiones: el patrón de alimentación de los prematuros a los 3-4 años y las estrategias de sus padres fueron adecuados, y la calidad de la dieta moderada. Es importante un adecuado seguimiento de los prematuros con menor edad gestacional, ya que presentaron más dificultades en la alimentación y menor peso.

Prenatal and Birth Care of Roma Women.

BACKGROUND: The reproductive health of Roma women has been poorly studied. It is important to determine the follow-up care received by Roma women from pregnancy to the first postpartum visit, together with neonatal outcomes, to improve prenatal care and maternal-child outcomes. OBJECTIVE: The aim of this study was to examine differences in prenatal care and maternal-infant outcomes between Roma and non-Roma women. METHODS: A retrospective longitudinal study was conducted in 122 pregnant women (28 Roma and 94 non-Roma women) recruited from seven primary care centers in three districts of Asturias (Spain). Sociodemographic variables, prenatal control, birth characteristics, feeding, and neonatal outcomes (gestational age, weight, and APGAR [appearance, pulse, grimace, activity, and respiration]) were collected from the electronic medical records. Prenatal care was assessed using three indices: the Kessner index, the Modified Adequacy of Prenatal Care Utilization Spanish Index, and an ad hoc index that considered adherence to the recommendations for pregnant women in Spain. RESULTS: Compared with non-Roma women, advanced maternal age (≥35 years) and primigravida were less common among Roma women. Roma women visited the dentist less often, smoked more, and underwent group B streptococcus screening less frequently. No differences were found in the number of prenatal visits between Roma and non-Roma women. Consequently, there were no differences between the Kessner index and the Modified Adequacy of Prenatal Care Utilization Spanish Index. Using the ad hoc index, the non-Roma women more frequently had adequate prenatal visits. There were no differences in birth characteristics, type of feeding, and neonatal outcomes. DISCUSSION: Overall, prenatal care was slightly worse in Roma women; however, this did not imply worse neonatal health outcomes. Both study groups had similar birth characteristics and immediate puerperium, including feeding.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

Background: Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods: A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results: A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.

Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons.

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007-2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

Evolution of Nursing Workload Indicators Since the Implementation of the Electronic Health Record at a Tertiary Hospital in Spain.

Nurses can be overwhelmed by the growing need for documentation derived from the implantation of electronic health records. The objective was to describe the evolution of nursing workload since the implementation of the EHR. We performed a longitudinal study of global workload indicators over a 5-year period at a referral hospital in Spain since introduction of the EHR (2014). Clinical activity records of each nurse were monitored using audit logs of their accesses to EHRs. During the study period, the number of EHR sessions, the number of EHR sessions in which a nursing order was changed, and the time needed to complete each session significantly increased. The number of mouse clicks and keystrokes and the time required to complete each nursing order decreased. Documentation of the following nursing tasks increased: administration of medication, peripheral vascular catheters, urinary catheters, pressure ulcers, nursing assessment forms, and pre-surgical verification. In conclusion, since the implementation of the EHR, an increase in the workload of nursing professionals-estimated through indirect indicators-has been observed due to greater documentation.

Gender roles and intimate partner violence among female university students in Spain: A cross-sectional study.

BACKGROUND: Traditional gender roles (GRs) have a considerable influence on relationships among couples. These can lead to negative health effects in women; however, their impact on intimate partner violence (IPV) has been less explored, especially among younger women. OBJECTIVE: To explore the association between traditional GRs and several indicators of IPV on a sample of Spanish female university students involved in heterosexual dating relationships. METHODS: A cross-sectional study involving female university students (n = 1,005) pursuing ten degrees (four Health Science degrees and six Social Sciences degrees). Data were collected using two validated scales: 1) the Questionnaire on the Gender Determinants of Contraception (COGANT), used to examine four traditional GRs (submissive, blind, and passive attitudes of female students, and male dominance), and 2) the Dating Violence Questionnaire-R (DVQ-R) scale, used to measure five types of IPV-behaviors (coercion, detachment, humiliation, sexual violence, and physical violence), perceived fear, entrapment, and abuse. Logistic and linear regressions were conducted to study the association between GR and a series of IPV indicators in dating relationships. RESULTS: Traditional GRs were highly prevalent (57.0% submissive, 52.0% blind attitude, 75.7% passive, and 31.7% identified their boyfriend as being dominant). Up to 66.3% experienced some type of violent behavior. All GRs were significantly associated with IPV indicators. A submissive attitude in female students was the GR that was most strongly associated to total IPV-behavior (adjusted odd ratio [OR] = 3.18; 95% confidence interval [CI]: 2.29-4.42), followed by male dominance (OR = 2.79: 95% CI:1.71: 4.54). Both GRs were also highly associated with perceived fear, entrapment, and abuse. CONCLUSIONS: A high presence of traditional GRs was found in the relationships held by female university students, which was significantly associated with IPV indicators. Universities must adopt policies for gender equality and raise awareness on dating violence.

Long-Term Care Facilities and Nursing Homes during the First Wave of the COVID-19 Pandemic: A Scoping Review of the Perspectives of Professionals, Families and Residents.

The COVID-19 pandemic has had significant repercussions for nursing home residents, their families, and professionals. The objective was to describe the perspectives of residents, their families, and nursing home employees during the COVID-19 pandemic. A scoping review was carried out using the PRISMA Extension for Scoping Reviews. The inclusion criteria were: qualitative and/or mixed methods studies in English, French, Portuguese, and Spanish. The review covers studies published from 11 March 2020 to 15 February 2021. CINAHL, PubMed, Web of Science, ScienceDirect, Scopus, British Nursing Index, Proquest, PsycInfo, and Google Scholar databases were used. We conducted a systematic narrative synthesis, presenting the results narratively and showing descriptive statistics on the studies reviewed. Sixteen documents were obtained from 175 results. Two studies focused on residents and one on their families. The remaining studies looked at professionals. Nursing homes had great difficulty managing resources, which was exacerbated by emotional exhaustion among residents, employees, and family members. In nursing homes, creative initiatives and new forms of leadership appeared to meet emerging needs during the pandemic. The results of the study show the impact of the pandemic on nursing homes and the response capacity present among residents, family members, and professionals.

Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost.

Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007-2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups' weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.

Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain.

BACKGROUND: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.

Contribution of students to nursing practice settings during clinical training: Design and validation of a questionnaire.

BACKGROUND: A validated questionnaire to measure the contributions of nursing students to clinical settings could potentially assist in the improved management of students in healthcare institutions. AIM: To develop and test the psychometric properties of the questionnaire 'Nursing Student Contributions to Clinical Settings' (CEEEC, Spanish acronym for 'Contribuciones de los Estudiantes de Enfermería a los Entornos Clínicos'). DESIGN: Instrument design and psychometric testing. PARTICIPANTS/SETTINGS: A multicentre study involving 1,098 nursing professionals from three universities and five hospitals of Spain, between January 2019 and March 2020. METHODS: The study was carried out in two phases. Phase 1 involved the questionnaire design by experts (n = 28), which required a review of the available literature, cognitive interviews and Delphi rounds, and a preliminary validity study, which included a pilot test with responses from a sample of nurses (n = 143). Phase 2 involved a formal validation with a wider sample of nurses (n = 927), including factor analysis and a study of convergent validity with the Practice Environment Scale-Nursing Work Index and Health Sciences-Evidence Based Practice. RESULTS: Experts selected 42 items on student contributions. After cognitive interviews, three items were eliminated and seven failed to reach the minimum content validity index (78%). Based on the remaining 32 items, the discrimination index of each item was calculated, and those with <0.3, eight items were sequentially eliminated. The resulting questionnaire contained 24 items grouped into a single factor, which explained 41% of the variance. The internal consistency was excellent (Cronbach's alpha: 0.94), and the convergent validity was confirmed. CONCLUSIONS: A 24-item questionnaire was designed and validated to measure the contributions of nursing students to clinical practice settings. IMPACT: Most hospitals are also teaching centres where nursing students undergo clinical practice. The application of this test will provide insight into the nursing professionals' perception of the students' role.

A mixed-methods study to evaluate the acceptability of information leaflets for breast cancer screening.

AIMS AND OBJECTIVES: To obtain feedback regarding the comprehension and acceptability of an information leaflet on breast cancer screening among women. BACKGROUND: Women usually receive a leaflet inviting them to participate in breast cancer screening programmes for early detection of breast cancer. These leaflets include relevant information about mammograms to aid with decision-making. It is important to know how the target population perceives these leaflets, as this may influence the attitude towards breast cancer screening. DESIGN: A mixed-methods study (concurrent triangulation design). METHODS: Participants were 41 women aged between 40-60 years in the north of Spain. The leaflet included information about breast cancer, mammograms, benefits/risks of screening, and the breast cancer mortality and survival rates in relation to screening. Three written methods were used to assess the leaflet: a readability assessment (Flesch Index) and two comprehension assessments (Cloze and multiple-choice questions). In addition, 26 semi-structured interviews were conducted to explore the women's opinions regarding comprehension, acceptability and the contribution of the leaflet as a decision aid. The COREQ checklist was used to guarantee the quality and rigour of the qualitative study. RESULTS: Overall, women found the leaflet fairly easy to read and most understood the content. Some women found the information on mortality alarming, difficult to understand and a cause for rejection. The leaflet was viewed as a decision aid, although further information was requested on mammograms, the need for complementary tests and the risks and symptoms of breast cancer. CONCLUSION: The leaflet was accepted by women and, overall, easy to understand. The participation of the target population enabled the content and format of the leaflet to be adjusted to their needs. RELEVANCE FOR CLINICAL PRACTICE: Nurses can contribute towards improving the breast cancer screening leaflets, considering women's perceptions surrounding screening.

Integración social y cribado del cáncer ginecológico de las mujeres inmigrantes en España / Social integration and gynecologic cancer screening of immigrant women in Spain

OBJETIVO: Explorar la asociación entre la condición de inmigrante y la realización de citologías y mamografías, y estudiar el efecto de la integración social en dicha asociación. MÉTODO: Análisis secundario de la Encuesta Nacional de Salud de España 2012. Se analizaron datos de 8944 mujeres de 18-75 años. Las variables dependientes fueron la realización de citologías y mamografías según las recomendaciones de la comunidad de residencia. Se estimó el nivel de integración mediante el soporte social percibido (escala Duke-UNC) y el número de años en España. Se utilizaron regresiones logísticas para calcular odds ratios (OR) e intervalos de confianza del 95% (IC95%) ajustados por confusores sociodemográficos y sanitarios. RESULTADOS: Respecto a las mujeres autóctonas, las OR ajustadas (IC95%) asociadas al incumplimiento de las recomendaciones de cribado de las mujeres inmigrantes fueron 1,31 (1,06-1,63) para las citologías y 3,13 (2,14-4,58) para las mamografías. Cuando se ajusta adicionalmente por el soporte social y el tiempo de permanencia en España, las asociaciones se atenúan y dejan de ser estadísticamente significativas (OR: 1,08, IC95%: 0,77-1,52 para citologías; OR: 1,62, IC95%: 0,97-2,74 para mamografías). CONCLUSIONES: Las mujeres nacidas en el extranjero participan menos en los programas de cribado del cáncer ginecológico que las nacidas en Espãna. El soporte social percibido por las mujeres inmigrantes y el tiempo de permanencia en Espãna explican gran parte de las diferencias entre inmigrantes y autóctonas

OBJECTIVE: To explore the association between immigrant status and performance of pap-smear and mammography, and to study the potential effect of social integration on that association. METHOD: Secondary analysis of the National Health Survey of Spain 2012. Individual data from 8944 women aged 18-75 were analyzed. Dependent variables were the performance of pap-smear tests and mammographies according to the guidelines of the state of residence. The level of integration in Spain was estimated through perceived social support (Duke-UNC scale) and the number of years living in Spain. Logistic regressions were used in order to obtain odds ratios (OR) and their 95% confidence intervals (95%CI), adjusted for confounders (sociodemographic and health-status). RESULTS: Compared to natives, immigrant women were more likely to not adhere to cervical cancer screening (OR: 1.31; 95%CI: 1.06-1.63) or breast cancer screening (OR:=3.13; 95%CI: 2.14-4.58). Additional adjustment by social support and length of residence in Spain attenuated the association, consequently losing statistical significance (OR: 1.08, 95%CI: .77-1.52 for pap-smear; OR: 1.62, 95%CI: .97-2.74 for mammographies). CONCLUSIONS: The probability of participating in the screening programs for gynecological cancer was lower if women were born abroad. Perceived social support and time living in Spain of immigrant women explained to a large extent the differences between immigrants and natives

Nursing Students' Experiences of Clinical Practices in Emergency and Intensive Care Units.

Clinical practices are key environments for skill acquisition during the education of nursing students, where it is important to encourage reflective learning. This study sought to explore the experience of final year nursing students during their clinical placement in emergency and intensive care units and to identify whether differences exist between female and male students. Using qualitative methodology, a documentary analysis of 28 reflective learning journals was carried out at a public university in Northern Spain. Four themes were identified: "an intense emotional experience", "the importance of attitudes over and above techniques", "identifying with nurses who dominate their environment and are close to the patient in complex and dehumanized units" and "how to improve care in critically ill patients and how to support their families". The female students displayed a more emotional and reflective experience, with a strong focus on patient care, whereas male students identified more with individual aspects of learning and the organization and quality of the units. Both male and female students experienced intense emotions, improved their learning in complex environments and acquired attitudes linked to the humanization of care. However, the experience of these clinical rotations was different between female and male students.

Young Nursing Student's Knowledge and Attitudes about Contraceptive Methods.

PURPOSE: Adolescence is considered a period in which individuals are particularly at risk of negative consequences related to sexual health. Increased knowledge levels have traditionally been used as an indicator of the effectiveness of educational programs, but attitudes are not addressed and are a key element for the success of such programs. The aim of this study is to determine the level of knowledge and attitudes toward the use of contraceptive methods among nursing students. A multicenter cross-sectional study was carried out. In total, 2914 university students (aged 18-25 years) enrolled in the study. Participants completed two validated scales to measure knowledge level and attitudes toward contraceptive use. Nursing degree students who received training about contraceptives obtained a success rate of over 70%, compared to 15.3% among students who had not received such training (p < 0.001). The mean attitude score was 43.45 points (10-50), but there were no significant differences in terms of student training (p = 0.435), although they were significantly higher among students who used contraceptives at first or last sexual intercourse (p < 0.001). There was a significant weak correlation between the level of knowledge and attitudes toward the use of contraceptives. An adequate level of knowledge about sexuality and contraceptive methods does not correspond to positive attitudes toward their use, although having an excellent attitude toward contraceptive use is related to their use during youth and adolescence.

[Impact of the chronic disease care program on social determinants of health in Asturias.] / Impacto de la Estrategia de Salud y Atención a la Población con Enfermedad Crónica sobre los determinantes sociales de la salud en Asturias.

OBJECTIVE: Providing care for people with chronic diseases is a challenge requiring institutional programs and strategies, thus it necessary to evaluate the impact of the same on the social determinants of health (SDH). The aims were: 1) to describe the impact of the structural determinants of the Health Strategy for the Population with Chronic Diseases (EAPEC) in Asturias and 2) to propose actions for improvement regarding social stratification factors. METHODS: Qualitative study of six strategic programs of the Chronic Disease Strategy: Health Observatory, Social and Healthcare Coordination, School for Patients Program, Caregivers Program, Mental Health Services Continuity, and Quality and Safety in Healthcare. A screening tool was used, validated for evaluation of the health impact on the structural determinants (socioeconomic and political context and social stratification factors) of the SDH. A personal semi-structured interview was carried out with the manager of each program in 2016, and a final report was produced that included the impacts found and proposals for improvement. RESULTS: All programs had a positive impact on social values (social justice, equity) and the state of wellbeing (social and educational policies). In terms of social stratification, the principal positive effects included age and functional diversity. Regarding the factors linked to geographic location, gender, origin/ethnicity, and social class the principal effects were negative. CONCLUSIONS: This strategy aimed at people with chronic diseases has positive effects. However, paying attention to social stratification factors during implementation of the same is a priority.

OBJETIVO: La atención a personas con enfermedades crónicas es un reto que precisa de estrategias y programas institucionales, siendo necesario evaluar su impacto en los determinantes sociales de la salud (DSS). Los objetivos de este trabajo fueron tanto describir el impacto en los determinantes estructurales de la Estrategia de Salud y Atención a la Población con Enfermedad Crónica (EAPEC) de Asturias como proponer acciones de mejora en relación con los factores de estratificación social. METODOS: Se realizó un estudio cualitativo de 6 programas estratégicos de la Estrategia de Cronicidad: Observatorio de Salud, Coordinación Sociosanitaria, Escuela de Pacientes, Atención a Personas Cuidadoras, Continuidad Asistencial en Salud Mental, Calidad y Seguridad en Atención Sanitaria. Se utilizó una herramienta de cribado validada para la evaluación del impacto en la salud sobre los determinantes estructurales (contexto socioeconómico y político, factores de estratificación social) de los DSS. Se realizó una entrevista personal semiestructurada con el responsable de cada programa en 2016, elaborando un informe final con los impactos detectados y propuestas de mejora. RESULTADOS: Todos los programas tuvieron un impacto positivo sobre los valores sociales (justicia social, equidad) y el estado de bienestar (políticas sociales, educativas). Dentro de la estratificación social, los principales efectos positivos afectaron a la edad y a la diversidad funcional. En los factores vinculados a la localización geográfica, género, origen/etnia y clase social se concentraron los principales efectos negativos. CONCLUSIONES: Esta estrategia dirigida a personas con enfermedades crónicas tiene efectos positivos. Sin embargo, es prioritario prestar atención a los factores de estratificación social durante su ejecución.

Tolerance of intimate partner violence and sexist attitudes among health sciences students from three Spanish universities / Tolerancia de la violencia en la pareja y las actitudes sexistas entre estudiantes universitarios/as de ciencias de la salud de tres universidades españolas

OBJECTIVE: To explore university health science students' intimate partner violence tolerance and sexist attitudes and to examine their trend throughout the academic years. METHODS: Cross-sectional study of students of both sexes of the degrees of medicine, nursing, and psychology from three selected Spanish universities (n = 1,322). Data were collected anonymously using two validated scales: the Dating Violence Questionnaire (DVQ-R) and the Gender Role Attitudes Scale (GRAS). Logistic regressions were used to compare tolerance toward violence and sexist attitudes across the degrees. The evolution of these variables throughout different academic courses was assessed. RESULTS: Of the sample, 62.8% were tolerant towards intimate partner violence. The percentage of tolerant students was significantly higher in Psychology (75.9%) than in Nursing (57.7%) and Medicine Degrees (60.3%). A higher percentage of sexist students was also found in psychology students (80.8%) than in nursing (62.2%) and medicine students (62.7%).compared to the first-year students, female medicine students of the last courses were less tolerant to intimate partner violence (p-trend <0.001), and male medicine students had less sexist attitudes (p-trend = 0.002). CONCLUSIONS: Tolerance of intimate partner violence and sexist attitudes were very high, especially among psychology students. These indicators were significantly better among medicine students of higher courses, suggesting a positive effect of medical training. Intimate partner violence in the university education of the future health professionals should be addressed

OBJETIVO: Explorar la tolerancia de la violencia en la pareja y las actitudes sexistas en estudiantes universitarios/as de ciencias de la salud, y estudiar su tendencia a lo largo de los cursos. MÉTODO: Estudio transversal en estudiantes de ambos sexos de medicina, enfermería y psicología de tres universidades españolas (n = 1322). Se utilizaron dos escalas validadas y anónimas: Cuestionario de Violencia entre Novios-Revisado (DVQ-R) y Escala de Actitudes de Rol de Género (EARG). Mediante regresiones logísticas se compararon la tolerancia al abuso y las actitudes sexistas entre titulaciones, y se estudió su evolución a lo largo de la formación académica. RESULTADOS: El 62,8% se mostraron tolerantes ante la violencia en la pareja. El porcentaje de estudiantes tolerantes fue significativamente más elevado en psicología (75,9%) que en enfermería (57,7%) y medicina (60,3%). También se encontró un mayor porcentaje de estudiantes sexistas en psicología (80,8%) que en enfermería (62,2%) y medicina (62,7%). En comparación con estudiantes de nuevo acceso, las estudiantes de medicina de los últimos cursos fueron menos tolerantes a la violencia (p <0,001) y los estudiantes de medicina varones tuvieron menos actitudes sexistas (p = 0,002). CONCLUSIONES: La tolerancia de la violencia en la pareja y las actitudes sexistas fueron muy elevadas, especialmente en psicología. Estos indicadores fueron significativamente mejores en estudiantes de medicina de los cursos superiores, lo que sugiere un efecto positivo de la formación médica. Se debería mejorar el abordaje de la violencia en la pareja en la formación universitaria de los/las futuros/as profesionales sanitarios/as